Can Testosterone Induce Blood Clots and Thrombosis? Interview with Dr Charles Glueck

[Nelson Vergel]

Latest study shows fewer DVT events in men on TRT vs not on TRT:

 

[Nelson Vergel]

Two blood tests are commonly used to measure a dog's ability to clot: prothrombin time, or PT, and activated partial thromboplastin time, or aPTT. These tests have an established normal reference range. Animals with results that are longer than normal are considered at risk of abnormal bleeding. However, when a clotting time was shorter than normal, clinicians have typically dismissed it.
"In the past," Silverstein said, "we've always said, no, it's probably that you pulled the sample incorrectly or the handling of the sample was inappropriate, even though logically you would think that a shorter time might indicate the animal is hypercoagulable.
"This study was attempting to say, can we actually use a shortened prothombin time or activated partial thromboplastin time to identify patients with hypercoagulability," she added.

http://m.phys.org/news/2016-05-animals-blood-clots.html

 

[Nelson Vergel]

Testosterone treatment and risk of venous thromboembolism: population based case-control study

This study showed increased risk in first 6 months only. It makes sense since it takes that long for the body to adjust to higher hematocrit and estradiol.

 

[Nelson Vergel]

From a pharma company.


Association between Use of Exogenous Testosterone Therapy and Risk of Venous Thrombotic Events among Exogenous Testosterone Treated and Untreated Men with Hypogonadism.


Li H, et al. J Urol. 2016.
Authors
Li H1, Benoit K2, Wang W2, Motsko S2.
Author information
1Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana. Electronic address: [email protected].
2Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana.

Citation
J Urol. 2016 Apr;195(4 Pt 1):1065-72. doi: 10.1016/j.juro.2015.10.134. Epub 2015 Oct 31.

Abstract

PURPOSE: Limited information exists about whether exogenous testosterone therapy is associated with a risk of venous thrombotic events. We investigated via cohort and nested case-control analyses whether exogenous testosterone therapy is associated with the risk of venous thrombotic events in men with hypogonadism.

MATERIALS AND METHODS: Databases were reviewed to identify men prescribed exogenous testosterone therapy and/or men with a hypogonadism diagnosis. Propensity score 1:1 matching was used to select patients for cohort analysis. Cases (men with venous thrombotic events) were matched 1:4 with controls (men without venous thrombotic events) for the nested case-control analysis. Primary outcome was defined as incident idiopathic venous thrombotic events. Cox regression and conditional logistic regression were used to assess HRs and ORs, respectively. Sensitivity analyses were also performed.

RESULTS: A total of 102,650 exogenous testosterone treated and 102,650 untreated patients were included in cohort analysis after matching, and 2,785 cases and 11,119 controls were included in case-control analysis. Cohort analysis revealed a HR of 1.08 for all testosterone treated patients (95% CI 0.91, 1.27, p = 0.378). Case-control analysis resulted in an OR of 1.02 (95% CI 0.92, 1.13, p = 0.702) for current exogenous testosterone therapy exposure and an OR of 0.92 (95% CI 0.82, 1.03, p = 0.145) for past exogenous testosterone therapy exposure. These results remained nonstatistically significant after stratifying by exogenous testosterone therapy administration route and age category. Most sensitivity analyses yielded consistent results.

CONCLUSIONS: No significant association was found between exogenous testosterone therapy and incidents of idiopathic or overall venous thrombotic events in men with hypogonadism. However, some discrepant findings exist for the association between injectable formulations and the risk of overall venous thrombotic events.

 

[MikeXL]

Is that stratified by dose? My concern with these huge studies is whether the stats are being twisted by people getting tiny doses from gel/cream?

 

[Boulderita]

This thread is incredibly insightful and helpful. I've been having a very difficult time finding precise data on Clomid to increase T vs exogenous T for clotting risks. My partner just had a PE after 7+ years on either androgen or Clomid (last 4+ years). He spends a lot of time on airplanes and has some family history of clots. We're starting the difficult process of deciding how to proceed, though he'll definitely stay on anticoagulants for the next 6 months. I'm a little suspect that almost all of the studies on this topic are from one guy who I'd imagine is pretty anti HRT.

 

[Boulderita]

Hey, Marco, are you still around? I was wondering if you have any updates from the past few years.

 

[Geo1062]

I'm currently a 49-year-old male who is been diagnosed with low testosterone , I currently take warfarin because I have factor five Leiden, have been dose stable for 8 years 7.5 mg ave per days 30 days, 5 mg daily with 1/2 of 5 mg every other day (pt/inr 2.4) this is tested at home and at dr office, I have been through 7 physicians and endocrinologists. All have remove me from their patient group because they feel issuing testosterone for treatment (255 (bottom 5 %) tested 6 days ago), is too risky stating lack of research on therapeutic warfarin patients. all of the research that I am able to find via the Internet and medical journals shows that testosterone therapy increases hypercoagulability with warfarin patients , which would indicate a lower level of warfarin needed should testosterone therapy be started to remain therapeutic , I have lived with this condition now for eight years I have a very good understanding of warfarin therapy along with my condition. I'm currently fighting an uphill battle to find a physician that is willing to treat the condition, thyroid has been tested and ruled out , tumor ruled out, enlarged prostate has been ruled out . Looking for help for a better quality of life not only for myself but my wife. Symptoms of low testosterone started showing up approximately six years ago they involved night sweats, lack of motivation , lack of sexual drive , muscle loss , slowed hair growth, Excessive weight gain (cortisol levels are at the high-end of the gray area) I also take lisinopril 20/12.5 for elevated blood pressure which started a year after warfarin therapy , A1 C levels also show elevated approximately one year after starting warfarin therapy, D3 deficiency also started one year after warfarin therapy.

 

[Nelson Vergel]

Geo1062

You may want to reach out to Defy Medical. If you are willing to sign a waiver they may be able to review your case.

The data shown in this long thread (this is page 5!) points to the fact that there is no consensus on the fact that men on warfarin with factor five Leiden may have increased risk of clotting or DVT issues on TRT.

 

[Geo1062]

Thank you that was my conclusion.

 

[MichaelMedeir]

I will be contacting Dr. Glueck with my concerns and report back in hopes I can ascertain some type of more aggressively-managed protocol for those of us at risk or who suspect risk while commencing TRT. Warfarin (coumadin) is only one type of anticoagulant, acting as a Vit K antagonist, blocking its action, and aspirin (and prescription anticoagulants like Plavix) only works to prevent platelet aggregation, however, there are other anticoagulants that work upon the clotting cascade entirely differently that as far as I know were not used in his research. These would be the older ones, i.e. Lovenox, heparin, and the much newer direct thrombin inhibitors like Xarelto, Eliquis and Pradaxa.

As far as AIs to control E2, I am at a loss as to what will not affect the clotting cascade in some way; they all do. Perhaps natural AIs are thew only safe ones. In my case, I have the opposite issue, as my E2 is almost non-existent. Yet another argument in favor of TRT.

Also – it would be interesting to see if having therapeutic phlebotomies would have prevented clots in those subject.



With the aggressive marketing of global TRT clinics, I expect we will see an incidence of thrombotic events increasing as more men commence TRT. This will greatly increase the necessity to overcome the hurdle as to what prophylactic measures can be taken to prevent future episodes, some of which can be fatal in the event a DVT causes PE.

The increased quality of life caused a strong addiction to TRT. I acquired substances at the gym. I had reoccurring PE's on xarelto, warfarin, and then lovenox. I was diagnosed with having antiphospholipid antibodies. Each PE occured almost immediately after starting weekly doses of Testosterone Enanthate (250mg). I realise now how foolish I was and I'm lucky to be alive. I made lifestyle changes that started with a healthier diet consuming more plant based foods and increased activity. I will never take any exogenous hormones again.

I am convinced that NOTHING will prevent DVT, if there are underlying conditions. It is not dose dependent either. I experimented, and each time produced the same result.

 

[Marco N Cognito]

Hey, Marco, are you still around? I was wondering if you have any updates from the past few years.

Yes, still around. Nothing new. Still in limbo on this conundrum, but haven't given up looking into workarounds. At this point, I don't think there's anything currently available that doesn't have some degree of risk, so it's all about risk management, whether it's TRT, clomiphene, or something else.

 

[Marco N Cognito]

The increased quality of life caused a strong addiction to TRT. I acquired substances at the gym. I had reoccurring PE's on xarelto, warfarin, and then lovenox. I was diagnosed with having antiphospholipid antibodies. Each PE occured almost immediately after starting weekly doses of Testosterone Enanthate (250mg). I realise now how foolish I was and I'm lucky to be alive. I made lifestyle changes that started with a healthier diet consuming more plant based foods and increased activity. I will never take any exogenous hormones again.

I am convinced that NOTHING will prevent DVT, if there are underlying conditions. It is not dose dependent either. I experimented, and each time produced the same result.

If you were using UGL gear, that's a whole other world of risks vs. medically-supervised TRT. Just curious - did you ever try Clomid as an alternative to exogenous testosterone?

 

[MichaelMedeir]

Yes Clomid

If you were using UGL gear, that's a whole other world of risks vs. medically-supervised TRT. Just curious - did you ever try Clomid as an alternative to exogenous testosterone?

Agree, definitely bigger risks, but I didn't opt for low grade products. I was using Testosterone as a performance enhancer and to improve libido for several years. I had a very physical job, and Testosterone has many benefits not often outlined in the mainstream. As I aged, more-so as a libido boost. To answer your question, not as an alternative, but yes, Clomid was my choice medicine after a 3 month cycle. We called it Post Cycle Therapy. I usually did two cycles a year and took Clomid the following four weeks (tapered doses) of a cycle. Clots didn't form until roughly 15 years of use. Which is something I find very odd. I miss the feeling of well being, quick recovery from strain, and the strong libido. Definitely depressing and addictive.

 

[Marco N Cognito]

Agree, definitely bigger risks, but I didn't opt for low grade products. I was using Testosterone as a performance enhancer and to improve libido for several years. I had a very physical job, and Testosterone has many benefits not often outlined in the mainstream. As I aged, more-so as a libido boost. To answer your question, not as an alternative, but yes, Clomid was my choice medicine after a 3 month cycle. We called it Post Cycle Therapy. I usually did two cycles a year and took Clomid the following four weeks (tapered doses) of a cycle. Clots didn't form until roughly 15 years of use. Which is something I find very odd. I miss the feeling of well being, quick recovery from strain, and the strong libido. Definitely depressing and addictive.

Yes, am familiar with Clomid being used for PCT, however, I was referring to it as a sole TRT alternative as the whole reason anyone would want to use it for that which is two-pronged - 1) to avoid testicular atrophy and azoospermia that is associated with frank TRT, and 2) less or zero incidence of HPTA suppression that is also a given with TRT.

 

[GEORGE TOULIATOS]

Increased E2 is linked to thrombosis.AAS prolong bleeding time and affect coagulation(INR)

 

[BuzzSaw]

its a known fact that testosterone will increase RBC, but there is a simple fix for this as you all know, donate! however I agree that this side needs to be added to the label as many doctors today have no clue how to treat it, some even refuse to give a script for blood letting. so I agree with FDA on adding this side effect to the label.

True, but donating blood can tank ferritin levels (which is aggro, esp as it can affect the thyroid).

Saw this thread on Google re blood clots (I am experiencing pains that are associated with clots, so will get it check out first thing).

 

[Nelson Vergel]

Blocking Testosterone Increased Thrombosis in Men with Prostate Cancer

 

[Nelson Vergel]

Testosterone Therapy Does Not Increase DVT and Pulmonary Embolism in 71,000 Patients

 

[J2048b]

good to know, so not sure, but hoping my recent left calf dvt was caused by hereditary high cholesterol along with lack of exercise and cutting off circulation due to my occupation....